Provider Demographics
NPI:1760829709
Name:BUSENLEHNER, BRYCE JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:JACOB
Last Name:BUSENLEHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-1857
Mailing Address - Country:US
Mailing Address - Phone:361-883-6211
Mailing Address - Fax:361-882-4891
Practice Address - Street 1:1734 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-1857
Practice Address - Country:US
Practice Address - Phone:361-883-6211
Practice Address - Fax:361-882-4891
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52311207L00000X
TXR2068207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty